William Withering, in 1785, stated, in referring to digitalis: "Let the medicine therefore be given in the dose and at the intervals mentioned above:—let it be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; let it be stopped upon the first appearance of any of these effects."1 Since that time, however, it has become common medical practice to digitalize a patient initially and then to assume that a full effect will persist with an average maintenance dose. The purpose of this report is to call attention to a third stage of digitalization, following those of initial digitalization and maintenance: that of periodic augmentation.
Subject and Methods
Thirty-three patients were studied. Eighteen of them had been digitalized by other physicians in the conventional manner and maintained on an average maintenance dose without interruption for periods varying from 1 month to 15 years. Eleven